The role of clinical pharmacology in enhanced recovery after surgery protocols: a comprehensive review

Kaye, Alan D.; Renschler, Jordan S.; Cramer, Kelsey D; Klein, Kendall; Granier, Amanda L.; Hart, Brendon M.; Kassem, Hisham; Urits, Ivan; Cornett, Elyse M.; Viswanath, Omar

doi:10.5114/ait.2020.95020

Cited by 10 publications

(10 citation statements)

References 66 publications

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“…Therefore, the enhanced recovery after surgery (ERAS) protocol has been established to increase patient's well-being after surgery. One of the important aspects of ERAS is rational fluid and food restriction prior to anesthesia (Borys et al 2020;Kaye et al 2020;Taniguchi et al 2012). Both ERAS and the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend oral intake of a carbohydrate-rich drink prior to surgery (Nygren et al 2013;Weimann et al 2017).…”

Section: Introductionmentioning

confidence: 99%

The influence of fasting and carbohydrate-enriched drink administration on body water amount and distribution: a volunteer randomized study

et al. 2021

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Background Fasting prior to anesthesia is considered aspiration prophylaxis. However, prolonged food and drink restrictions may increase the risk of other complications. The aim of this study was to assess whether a carbohydrate-enriched drink (Nutricia™ preOp®), recommended by the enhanced recovery after surgery (ERAS) protocol, can improve body hydration in fasting healthy individuals. Methods Measurements were done with the bioelectric impedance analysis with a Fresenius body composition monitor. Body composition, total body water, water distribution, and hemodynamic parameters were measured at the beginning of the study and after 10 h and 12 h of fasting. Patients fasted for 10 h and then were divided into two groups: the control (n = 40) and the pre-op group (n = 41). The pre-op group received 400 mL of Nutricia™ preOp®, as suggested in the ERAS guidance. The two-tailed Student’s t test was used to compare two groups with normally distributed data and homogenous variances; if variances were heterogeneous, Welch’s test was used. The Mann-Whitney U test was used to compare two groups with non-normal data distribution. p < 0.05 was considered statistically significant. Results We found no significant differences between the control and pre-op groups regarding body water distribution and body composition. We did not observe significant losses in the total body water after fasting. Also, blood pressure was not affected by fasting. Conclusion We have proven that pre-op did not impact either body composition or body water. Trial registration ClinicalTrials.gov, NCT04665349. Registered on 11 December 2020—retrospectively registered.

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Section: Introductionmentioning

confidence: 99%

The influence of fasting and carbohydrate-enriched drink administration on body water amount and distribution: a volunteer randomized study

et al. 2021

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“…In particular, early mobilization reduces the risk of postoperative deep venous thrombosis and facilitates a faster return to daily routines by allowing an earlier restoration of both the bladder and bowel function 45 . The aforementioned parameters are compatible with the Enhanced Recovery After Surgery (ERAS) protocols that have been recently adopted by many institutions which have been related with favorable outcomes regarding patients' recovery 46 . A critical point for ERAS protocols is the reduction of opioid consumption which is achieved by using local anesthetics and nerve blocks 46 .…”

Section: Discussionmentioning

confidence: 93%

“…46 A critical point for ERAS protocols is the reduction of opioid consumption which is achieved by using local anesthetics and nerve blocks. 46 To that end, Athanasiou et al reported that the proportion of patients who consumed opioids under LA was significantly lower compared to those in RA group (p = .002).…”

Section: Comparative Studies/meta-analysismentioning

confidence: 99%

“…45 The aforementioned parameters are compatible with the Enhanced Recovery After Surgery (ERAS) protocols that have been recently adopted by many institutions which have been related with favorable outcomes regarding patients' recovery. 46 A critical point for ERAS protocols is the reduction of opioid consumption which is achieved by using local anesthetics and nerve blocks. 46 To that end, Athanasiou et al reported that the proportion of patients who consumed opioids under LA was significantly lower compared to those in RA group (p = .002).…”

Section: Comparative Studies/meta-analysismentioning

confidence: 99%

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Pelvic floor reconstructive surgery under local anesthesia: A systematic review and meta‐analysis

Zacharakis

Prodromidou

Douligeris

et al. 2021

Neurourology and Urodynamics

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Aims: The decision on the appropriate type of anesthesia for pelvic floor repair depends on a variety of factors including patients' age, performance status, comorbidities, cost-effectiveness and personal preferences. We aim to review the literature on urogynecological procedures performed under local anesthesia (LA).Methods: A systematic search of four electronic databases was conducted for articles published up to May 2020. Studies reporting outcomes of women who underwent pelvic floor reconstructive surgery under LA with or without sedation, were considered eligible.Results: Nineteen studies (14 noncomparative and 5 comparative), including 1626 cases of urogynecological procedures under LA were recruited. Metaanalysis revealed significantly lower mean pain scores in LA group compared to general-regional anesthesia one (GA/RA) at both 4-6 h and 8-18 h postoperatively (160 patients; mean difference [MD], −1.70; 95% confidence interval [CI]: −3.12, −0.28; p = 0.02 and 160 patients; MD, −0.72; 95% CI: −1.17, 0.27; p = 0.002, respectively). Pain scores at >24 h did not differ among the two groups (160 patients; MD, −0.28; 95% CI: −0.60-0.05; p = 0.10). Intra-and postoperatively morphine use was not different among patients who received LA and GA during prolapse surgery while nausea rates were significantly lower in LA group compared to RA group 8 h postoperatively. Conclusions: LA with or without sedation represents a safe and efficient alternative anesthetic technique for urogynecological procedures with improved pain scores in up to 18 h postoperatively especially in patients who underwent surgery for SUI. LA is feasible and could be offered to patients undergoing pelvic floor surgery allowing a prompt postoperative recovery.

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“…In our study, all patients were anaesthetized with the same anaesthetics. No premedication with anxiolytics was administered prior to surgery since avoiding these drugs is common clinical practice [22].…”

Section: Discussionmentioning

confidence: 99%

Prediction of the Occurrence of the Oculocardiac Reflex Based on the Assessment of Heart Rate Variability. An Observational Study

et al. 2022

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Introduction: Ophthalmic surgery is assumed to be safe, but some operations require general anaesthesia which is associated with a number of potential complications. In addition, adverse cardiovascular symptoms, such as severe slowing of the heart rate and, in some cases, cardiac arrest may occur due to the surgical technique. The aim of this study was to determine whether it is possible to predict the occurrence of oculocardiac reflex (OCR) based on heart rate variability (HRV) analysis for autonomic nervous system (ANS) activity assessment measured prior to the induction of anaesthesia and immediately before eyeball traction. Methods: Fifty-two adults of both sexes (age range 18-65 years) with American Society of Anesthesiologists (ASA) physical status class 1 and 2 were enrolled in this study. All patients had underwent episcleral buckling under general anaesthesia. High-frequency (HF) changes in HRV are thought to reflect parasympathetic impulse transmission, whereas low-frequency (LF) changes reflect both sympathetic and parasympathetic activity. However, in practice, LF changes can be considered to reflect sympathetic changes. Thus, the LF/HF ratio reflects the actual balance between sympathetic and parasympathetic activity. Based on that, frequency domain HRV parameters from 5-min Holter electrocardiogram recordings before anaesthesia induction and before eyeball traction were used for the analysis. The statistical analysis also included patient age, sex, ASA status and preanaesthesia and premanoeuvre heart rate and blood pressure. Results: Data from 42 patients were analysed. Oculocardiac reflex was observed in 32 patients (76.2%). No difference was found in the analysed parameters between patients with and without oculocardiac reflex. There was no relationship between the incidence of the OCR and the analysed parameters. Conclusion:The prediction of OCR based on initial ANS tone was not possible, and the initial heart rate, blood pressure, age, sex, and ASA status were not helpful for the identification of patients at risk of this reflex.

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The role of clinical pharmacology in enhanced recovery after surgery protocols: a comprehensive review

Cited by 10 publications

References 66 publications

The influence of fasting and carbohydrate-enriched drink administration on body water amount and distribution: a volunteer randomized study

The influence of fasting and carbohydrate-enriched drink administration on body water amount and distribution: a volunteer randomized study

Pelvic floor reconstructive surgery under local anesthesia: A systematic review and meta‐analysis

Prediction of the Occurrence of the Oculocardiac Reflex Based on the Assessment of Heart Rate Variability. An Observational Study

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